Symptoms & Causes of Robin Sequence

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Robin sequence occurs in approximately 1 in 8,500 to 14,000 births. There is a higher incidence of this combination of defects in twins. This may be due to crowding in the uterus, which restricts the growth of the lower jaw.

What are the Signs of Robin Sequence?

Robin sequence is a combination of birth defects that occurs in a developing fetus and that are apparent when your baby is born. These birth defects include:

  • Micrognathia: An underdeveloped or abnormally small lower jaw (mandible) that is much shorter than the rest of the face. The growth of the lower jaw may speed up during the first year of life.
  • Glossoptosis: A tongue that is positioned further back in the mouth than normal. Because of the small mandible, the tongue is too large for the airway. This can interfere with breathing.
  • Cleft palate: A cleft palate is a separation in the tissue that makes up the roof of the mouth (palate). For some babies, both the front and back parts of the palate are open. For other babies, only part of the palate is open. The cleft palate in Robin sequence is usually a rounded, or U-shaped cleft palate, in comparison to the more common V-shaped cleft palate seen in other conditions.

These defects result in a variety of symptoms, including:

  • Feeding difficulties: The smaller size of the lower jaw, position of the tongue and the cleft of the palate can make it difficult for your baby to feed normally. Your baby might be able to learn to feed with specially adapted nipples and bottles. More severe Robin sequence may require a temporary feeding tube.
  • Trouble breathing: Your child’s tongue may fall backwards, especially when he/she is lying on her back. This can block the throat and obstruct breathing and is of special concern when your baby sleeps. The majority of babies respond well to positioning on the stomach, which helps pull the tongue forward during sleep. Other infants may require nasal tubes or surgery to pull or push the tongue forward.

As a result of these symptoms, some babies struggle with growth and weight gain until treated.

Learn more about Robin Sequence treatments offered at Boston Children’s Hospital.

What Causes Robin Sequence?

Experts do not know the exact causes of Robin sequence. There may be a genetic cause.

This combination of birth defects can be seen in other syndromes, including:

  • Stickler syndrome: A genetic malfunction in the tissue that connects bones, heart, eyes and ears. A child with Stickler syndrome may have problems with vision, hearing, bones and joints, the heart and facial formation.
  • Velocardiofacial syndrome (VCFS): The most common features of this syndrome are cleft palate, heart defects and characteristic facial appearance, as well as minor learning problems and speech and feeding challenges.

Make an Appointment

For an appointment with the Cleft and Craniofacial Center, more information or to obtain a second opinion for your child, please call us at 617-355-6309 or email

International Patients

For families residing outside of the United States, please call Boston Children's International Health Services at +01-617-355-5209.

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